Josh Reandelar

Saturday overnight shift ⁦@UMEmergencyMed⁩ #foamed #WhiteBoardTeaching

Starting residency can be challenging—presenting 10 patients daily on floors is no joke! Here’s my approach to staying efficient: -Arrive early. -Review age, PMH, and chief complaint. -Check ED vitals, labs, imaging, and where the patient came from. -Review overnight events (ask the night team), vitals, and morning labs. -Check consultant notes (e.g., cardiology updates). -Update assessment/plan, and place necessary orders. -For new patients, review prior hospitalizations. -Track hospitalization course—know the big picture. -Check PT/case management for mobility concerns and placement. -After chart review, talk to nurses, check telemetry, and ensure alignment. -See patients, update them, take history, do a physical exam—always introduce yourself! -Review with seniors to catch anything missed. It’s challenging at first, but practice makes perfect. I hope this helps future interns; however, I am still learning and improving! #ResidencyLife #MedTwitter #Efficiency #medicine

Confession: I LOVE hyponatremia 🤓 (I know, I know. What can I say, I'm a true internist!) HypoNa is often feared, maligned, and misunderstood - but I promise it doesn't have to be scary! Here are my top 10 hyponatremia tips and tricks - a 🧵

Every week, I see a new study talking about this or that effect of GLP-1 receptor agonists like #ozempic. FINALLY, we have a study evaluating all the outcomes (good and bad) in one dataset. There are some... surprises. 🧵

(1/x) Intubating a critically ill patients is the most dangerous procedure we do in the ICU (3.1% cardiac arrest rate) not because of hypoxia or tube placement, but hemodynamic collapse 🫀 (Russotto et al. JAMA 2021) A 🧵on making high risk hemodynamic intubations as safe as possible.

There is no better feeling than walking into a shift and finding out the best nurses in your department are on your team for the day

“Ventilator Modes Overview 🫁: 1️⃣ VC (Volume Control): Fixed volume; good for LPV but risk of barotrauma. 2️⃣ PC (Pressure Control): Set pressure; prevents barotrauma but may cause hypoventilation. 3️⃣ PRVC: Adaptive mode; ensures tidal volume but increases work of breathing. 4️⃣ SIMV: Partial support; useful for weaning but less effective for full support. 5️⃣ PS (Pressure Support): Weaning mode; patient-triggered but no set rate. 6️⃣ APRV: ARDS mode; improves oxygenation but complex settings. VBG Interpretation 🩸: 1️⃣ pH: Evaluates ventilation. 2️⃣ pCO2: Adjust ventilation to correct acidosis/alkalosis. 3️⃣ FIO2 and PaO2: Assesses oxygenation. 4️⃣ SpO2: Monitor and adjust O2 delivery.

Student I was counting on to nod throughout the lecture stopped nodding

ICU (Central Venous/Arterial) Line Secrets - Part 1: An ICU where the patients have no central lines & are not connected to ventilators is not a real ICU. This may be a controversial statement but in my humble opinion not far from truth

1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what? T2 prolongation who? Here’s a translation w/an introductory thread to MRI.

today I apologized for asking a nurse a question and she responded with “in the clerb, we all fam”

1/ Why can furosemide improve dyspnea/pulmonary edema from acute congestive heart failure within minutes of administration? The answer does not involve diuresis. #medtwitter #tweetorial

@cocuzzo_kaitlyn @ClementLeeMD Got it, thank you!

@drmacjosh @ClementLeeMD No necessarily. Negative in the is excellent at ruling out a MRSA pneumonia (NPV is high) Positive is less meaningful in general. For other infections like cellulitis, septic joint, bacteremia etc the nose swab is less useful (positive or negative)

NEW: Kamala Harris has announced that, If elected, she will make it a FELONY to continue vancomycin if the MRSA swab is negative.

🧵regarding the useful technique of 'straightening the wire' during central line placement when the plastic guide is no longer within reach. If you do a lot of central lines (or a lot of percutaneous procedures), this technique will come in handy over and over again. (1/ )

Bringing this back for the new interns because this tweet completely shifted my perspective when I started last year. Good luck and enjoy!

In emergency medicine we don’t say “I love you” we say “why are you still here go home” and to me that’s beautiful

My favorite thing is that ortho fellowships are just named after the body part. Ppl like I matched hand! I matched elbow! I matched knee!

whoever came up with this shot needs a raise twitter.com/thexjoc/status…